人工耳蜗植入前后水平半规管及重力感知的评估

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中文摘要

背景/目的： 人工耳蜗植入（CI）可有效治疗重度至极重度感音神经性听力损失，但其对前庭功能的影响仍在研究中。本回顾性研究评估了围手术期水平半规管功能（视频头脉冲试验，vHIT）和重力感知（主观视觉垂直，SVV）的变化。方法：纳入2017年5月至2018年7月期间植入的43名成人（平均年龄：59 ± 15岁），在术前和术后进行评估。预先指定的主要分析是植入耳在60 ms时vHIT增益的配对比较，按植入侧分别进行；所有其他比较均为探索性。结果：43名参与者中有36名可获得配对vHIT数据。右侧CI后植入耳增益无变化（n = 17；1.52 ± 0.37至1.59 ± 0.63；变化：+0.07，95% CI：-0.41至0.56；t(16) = 0.32，p = 0.754），而左侧CI后下降（n = 19；中位数：1.41至1.07；z = -3.02，p = 0.003）；未对两侧进行正式比较。术后植入耳与非植入耳无差异（n = 37；p = 0.116）。36名参与者中有14名（38.9%）出现新的同侧代偿性扫视（精确McNemar p = 0.031和0.039）。SVV偏差为0.77 ± 0.47°和0.92 ± 0.51°（p = 0.086）。结论：右侧CI后或SVV未检测到显著变化；鉴于置信区间宽且样本量小，这并非功能保留的证据。左侧下降、新出现的同侧代偿性扫视以及探索性发现需要在更大规模的前瞻性研究中确认。

英文摘要

Background/Objectives: Cochlear implantation (CI) effectively treats severe-to-profound sensorineural hearing loss, but its vestibular effects remain under investigation. This retrospective study assessed perioperative changes in horizontal canal function (video head impulse test, vHIT) and graviceptive perception (subjective visual vertical, SVV). Methods: Forty-three adults (mean age: 59 ± 15 years) implanted between May 2017 and July 2018 were assessed pre- and postoperatively. The prespecified primary analysis was the paired comparison of vHIT gain at 60 ms in the implanted ear, performed separately by implantation side; all other comparisons were exploratory. Results: Paired vHIT data were available for 36 of 43 participants. Gain in the implanted ear did not change after right-sided CI (n = 17; 1.52 ± 0.37 to 1.59 ± 0.63; change: +0.07, 95% CI: -0.41 to 0.56; t(16) = 0.32, p = 0.754), whereas it fell after left-sided CI (n = 19; median: 1.41 to 1.07; z = -3.02, p = 0.003); the two sides were not compared formally. Implanted and non-implanted ears did not differ postoperatively (n = 37; p = 0.116). Fourteen of thirty-six participants (38.9%) developed new ipsilateral catch-up saccades (exact McNemar p = 0.031 and 0.039). SVV deviation was 0.77 ± 0.47° and 0.92 ± 0.51° (p = 0.086). Conclusions: No significant change was detected after right-sided CI or in SVV; given the wide confidence interval and the small sample, this is not evidence of preserved function. The left-sided reduction, the newly developed ipsilateral catch-up saccades and the exploratory findings require confirmation in larger prospective studies.